eMRCS Upper Limb and Breast Flashcards
Which of the following forms the floor of the anatomical snuffbox?
Radial artery Cephalic vein Extensor pollicis brevis Scaphoid bone Cutaneous branch of radial nerve
Scaphoid bone
The scaphoid bone forms the floor of the anatomical snuffbox. The cutaneous branch of the radial nerve is much more superficially and proximally located.
A 35 year old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian artery Subclavian vein External carotid artery Internal carotid artery Vertebral artery
Subclavian vein
The subclavian vein lies behind subclavius and the medial part of the clavicle. It rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).
A 32 year old attends neurology clinic complaining of tingling in his hand. He has radial deviation of his wrist and there is mild clawing of his fingers, with the 4th and 5th digits being relatively spared. What is the most likely lesion?
Ulnar nerve damage at wrist Ulnar nerve damage at elbow Radial nerve damage at elbow Median nerve damage at wrist Median nerve damage at elbow
Ulnar nerve damage at elbow
The ulnar paradox - the higher the lesion, the less the clawing of the fingers seen clinically.
At the elbow the ulnar nerve lesion affects the flexor carpi ulnaris and flexor digitorum profundus.
An 8 year old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?
Median Radial Ulnar Musculocutaneous Axillary
Median nerve
This is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury.
Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?
Triquetrum Lunate Pisiform Scaphoid Capitate
Pisiform
This small bone has a single articular facet. It projects from the triquetral bone at the ulnar aspect of the wrist where most regard it as a sesamoid bone lying within the tendon of flexor carpi ulnaris.
Which of the following nerves supplies the majority of the skin on the palmar aspect of the thumb?
Ulnar Median Radial Musculocutaneous None of the above
Median nerve
The median nerve supplies cutaneous sensation to this region.
A patient presents to the clinic following a surgical procedure. She complains that she is unable to shrug her shoulder. What is the most likely underlying nerve injury?
Accessory nerve Cervical plexus Ansa cervicalis Long thoracic nerve Axillary nerve
Accessory nerve
The accessory nerve may be injured in operations in the posterior triangle. Injury will affect trapezius.
A 38 year old man falls onto an outstretched hand. Following the accident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. What is the most likely injury in this scenario?
Rupture of tendon of flexor pollicis Scaphoid fracture Distal radius fracture Rupture of flexor carpi ulnaris tendon None of the above
Scaphoid fracture
FOOSH is a common mechanism of injury for a scaphoid fracture. This should be suspected clinically if there is tenderness in the base of the anatomical snuffbox. A tendon rupture would not result in bony tenderness.
A 78 year old man is lifting a heavy object when he feels a pain in his forearm and is unable to continue. He has a swelling over his upper forearm. An MRI scan shows a small cuff of tendon still attached to the radial tuberosity consistent with a recent tear. Which of the following muscles has been injured?
Pronator teres Supinator Anconeus Brachioradialis Biceps brachii
Biceps brachii
Biceps inserts into the radial tuberosity. Distal injuries of this muscle are rare but are reported and are clinically more important than more proximal ruptures.
Through which of the structures listed below does the axillary nerve pass?
Quadrangular space Triangular space Subclavicular space Subpectoral space Intercostal space
Quadrangular space
A 43 year old lady is due to undergo an axillary node clearance as part of treatment for carcinoma of the breast. Which of the following fascial layers will be divided during the surgical approach to the axilla?
Sibsons fascia Pretracheal fascia Waldeyers fascia Clavipectoral fascia None of the above
Clavipectoral fascia
The clavipectoral fascia is situated under the clavicular portion of pectoralis major. It protects both the axillary vessels and nodes.
During an axillary node clearance for breast cancer the clavipectoral fascia is incised and this allows access to the nodal stations. The nodal stations are; level 1 nodes inferior to pectoralis minor, level 2 lie behind it and level 3 above it.
During a Patey Mastectomy, surgeons divide pectoralis minor to gain access to level 3 nodes. The use of sentinel node biopsy (and stronger assistants!) have made this procedure far less common.
A 73 year old lady with long standing atrial fibrillation develops a cold and pulseless white arm. A brachial embolus is suspected and a brachial embolectomy is performed. Which of the following structures is at greatest risk of injury during this procedure?
Radial nerve Cephalic vein Ulnar nerve Median nerve None of the above
Median nerve
The median nerve lies close to the brachial artery (medial to it) in the antecubital fossa. This is the usual site of surgical access to the brachial artery for an embolectomy procedure. The median nerve may be damaged during clumsy application of vascular clamps to the artery.
A 73 year old man undergoes an excision biopsy of a lymph node that is closely applied to sternocleidomastoid. This muscle is mobilized and a nerve that is present is damaged. Which muscle below is most likely to be affected?
Trapezius Rhomboid major Deltoid Supraspinatus Rhomboid minor
Trapezius
The accessory nerve has a number of lymph nodes applied to it near the sternocleidomastoid muscle. It is particularly at risk if SCM is mobilized. If injured, the trapezius muscle and SCM will be paralysed.
Which of the following structures separates the ulnar artery from the median nerve?
Brachioradialis Pronator teres Tendon of biceps brachii Flexor carpi ulnaris Brachialis
Pronator teres (deep head)
The ulnar artery lies deep to pronator teres and this separates it from the median nerve.
Which of the following muscles lies medial to the long thoracic nerve?
Serratus anterior Latissimus dorsi Coracobrachialis Pectoralis minor None of the above
Serratus anterior
A 10 year old boy is admitted to the emergency department following a fall. On examination, there is deformity and swelling of the forearm. The ability to flex the fingers of the affected limb is impaired. However, there is no sensory impairment. Imaging confirms a displaced forearm fracture. Which of the nerves listed below is likely to have been affected?
Ulnar nerve Posterior interosseous nerve Anterior interosseous nerve Axillary nerve Radial nerve
Anterior interosseous nerve
Forearm fractures may be complicated by neurovascular compromise. The anterior interosseous nerve may be affected. It has no sensory supply so the defect is motor alone.
Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?
Pronator teres Biceps Brachialis Triceps Extensor carpi radialis longus
Brachialis
The brachialis inserts some of its fibres into the fibrous joint of the elbow capsule and when it contracts, it helps to flex the joint.
Which of the following muscles does not adduct the shoulder?
Teres major Pectoralis major Coracobrachialis Latissimus dorsi Supraspinatus
Supraspinatus
Supraspinatus is an abductor of the shoulder.
What is the course of the median nerve relative to the brachial artery in the upper arm?
Medial to anterior to lateral Lateral to posterior to medial Medial to posterior to lateral Medial to anterior to medial Lateral to anterior to medial
Lateral to anterior to medial
The median nerve descends lateral to the brachial artery, it usually passes anterior to the artery to lie on its medial side.
It passes deep to the bicipital aponeurosis and the median cubital vein at the elbow.
It enters the forearm between the two heads of the pronator teres muscle
